West Virginia Health Insurance Marketplace

With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.

The following guide offers a glimpse at the various types of ACA-compliant health insurance in West Virginia, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.

Health and healthcare in West Virginia

West Virginia ranked 44th in United Health Foundation’s 2014 America’s Health Rankings.1 Its strengths were listed as a low prevalence of binge drinking, a low incidence of infectious diseases, and high per capita health funding. Challenges West Virginia faces include high prevalences of smoking and physical inactivity, high prevalences of obesity and diabetes, and a high rate of preventable hospitalizations. In the pat five years, the percentage of West Virginia children under 18 in poverty decreased from 24 percent to 19 percent.

West Virginia individual and family health insurance

When creating its health insurance exchange under the Affordable Care Act, West Virginia opted for a state-federal partnership model. The state oversees plan management, and the federal government provides the Web portal consumers use to shop for coverage. West Virginians may use the Federal Health Insurance Marketplace website to find individual and family coverage

The U.S. Department of Health and Human Services reported that 19,856 individuals in West Virginia selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in West Virginia enrolled in a marketplace plan increased to 33,421 during the open enrollment period.3

West Virginia small group health insurance plans

Small business owners with 50 or fewer employees may purchase group health insurance plans through West Virginia’s Health Insurance Marketplace, as well as in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.

Self-employed individuals with no employees must apply for an individual health insurance plan on or away from West Virginia’s partnership exchange.

West Virginia state COBRA variations for small groups

The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.

In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.

West Virginia’s small group COBRA continuation variations are as follows4:

Mini-COBRA option

Yes

Eligible group sizes

2–19

Maximum continuation period – standard

18 months

Maximum premium Increase

100 percent

State legislation reference

§114-93-1—§114-93-3

Additional notes9

Covered employees and qualified beneficiaries must elect continuation coverage in writing to the carrier within 30 days of receiving notice of eligibility

West Virginia high-risk pools

It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated. 5

The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.

West Virginia Medicaid

Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6

Effective Jan. 1, 2014, West Virginia began expanding Medicaid to low-income adults without dependents in 2014.7 Medicaid/CHIP open enrollment takes place year-round.

The information below is specific to West Virginia’s Medicaid program:

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